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Baroness Maddock: My Lords, what concerns me is that there are all sorts of services to which people can be referred. The Government say that they will talk to housing authorities, and so on, but it is becoming second nature to know where to refer people. It is not always to the local authority—other agencies are doing it.

Baroness Andrews: My Lords, the assessment process is designed not to make a virtue out of referral but to make something happen. It brings people together. The noble Baroness is absolutely right that this is a point at which information can be usefully exchanged. It may in fact be the first time that some of these people have talked to each other. We expect something to happen arising from that.

Following the Secretary of State's announcement on 23rd July regarding older people's services, we will in due course be announcing details of a special grant to local councils to expand community-based social care services. That will include a specific ring-fenced investment of £9.5 million over the next three years in HIAs to contribute to reductions in delayed discharge by the prompt supply of minor housing works. So

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direct action is being taken. Similar funding is also being made available by the ODPM. I should prefer to write to the noble Baroness about that and about the recent joint work between the ODPM and the Department of Health about the guidance. I will circulate that.

In practical terms, we know that very few discharges are delayed entirely for housing reasons, but obviously they have a direct influence on many situations. I hope, given that assurance, that the noble Baroness will accept that we have entirely taken her point.

Amendment No. 17 would remove the words "if any" from Clause 3(3)(b). The words are there because the clause requires the local authority to consult the NHS and then decide what services it will provide. There may be circumstances in which no services are necessary, perhaps because the patient has made a complete recovery. We must make it possible for the local authority not to provide services. Therefore, the insertion of "if any" provides clarity on the face of the Bill that it is valid for the local authority to provide no services. On that basis, I hope that noble Lords will feel able to withdraw their amendment.

Amendment No. 18 would insert the words,

    "whether acting as purchaser or provider".

I presume that that is intended to clarify what is meant by the local authority deciding whether to make services available. We do not think that that adds much value to the clause because the term "make available" simply indicates that the social services are ready to comply and that the services are ready and available. There may be reasons why the services are not provided on the day of discharge—for example, the housing provision may not have been made—and the patient cannot be discharged, but we believe that "made available" encompasses preparation and availability.

Amendment No. 19 would add:

    "commensurate with the patient's needs".

Assessments carried out by the NHS or local authorities are not simply an academic exercise. The point is that the patient's health or social care needs should be met. As public bodies, local authorities are under a public law duty to do that, but there is a clear statement in the single assessment process that this is a system of care management that covers assessment, planning and service delivery. That package of care will test and secure good working relationships between all the health and social care professionals involved. The Bill reinforces that by requiring the local authority to consult the NHS when it is planning the patient's care package. It means mutual information and a commitment to making sure that the patient's needs are met. We have backed that up with a wide range of extra resources for the NHS and social services in relation to discharge.

We have tabled Amendment No. 24 to make the Bill fairer to local authorities and clearer and more sensitive to individual circumstances. I hope that it mitigates to some extent what the noble Lord said about our unfairness to social services. We already

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have the power in regulations to begin the assessment process again if the situation changes so markedly that what the NHS or social services planned to provide is no longer enough. That has gone into our new clause. The amendment covers a situation in which, during an extended hospital stay, the patient's condition improves beyond expectation, or perhaps their personal circumstances change so that they will find a relative in support when they go home. In those circumstances, a completely new assessment is probably not necessary, but the patient does not need all the services that social services had planned to provide. For example, a patient who has had a stroke and has a poor prognosis in the early days may make a rapid recovery and may not need physiotherapy that had been planned. The amendment allows social services, after consultation with the NHS, to change their decision about what services to provide to enable a safe discharge. It builds in flexibility and sensitivity to changing needs. Given the proviso that the local authority will not be able to make such a change without consulting the NHS body, I hope that noble Lords will accept that.

Amendments Nos. 26 and 29 are intended to cover the provision of services by other NHS bodies, such as primary care trusts, and to require that the relevant bodies agree with each other. I am afraid that we still feel that the amendments do not add anything to what is already in the Bill. They would require the NHS body to consider whether any other NHS body should provide services. The NHS body already needs to consider whether the trust or another NHS body has to provide services to the patient on discharge. Clause 3(8) states that the responsible NHS body, and any other NHS body that will be involved in providing health services, will need to consult the local authority. That will primarily be the primary care trust. The noble Baroness is right that the full range of services considered necessary should be available. The PCT will be providing those services and ensuring that, whether it is physiotherapy, speech therapy or dressings to be changed, the nursing support is there, the health visitors are organised and the physiotherapists are available. That depends on the PCT knowing what its task is and having liaised with the NHS. Following on from the acute trust's decision that the patient will need community health services, they will have to provide appropriate information to the other NHS bodies—otherwise nothing will happen—so that they can comply with their duties under subsection (3). I repeat that we do not think that anything needs to be added to the Bill, as this will happen as a matter of course and of logic.

Amendment No. 29 then states that the responsible NHS body must come to an agreement with the social services authority. I am sorry if I gave the impression of being anti-social services. I am certainly not and I did not intend to give that impression. The noble Baroness is right that agreement is essential before anything can be achieved. Our problem is that to include a duty on the face of the Bill in the way that she wants would, in the worst circumstances, offer a reason for failing to act or to come to an agreement.

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In that case the loss would be borne by the individual patient. We think it is right to try to protect them from that. It is a worst case analysis, but we have a duty to make sure that it does not happen. Subsection (8) as drafted is simpler and better.

The noble Earl, Lord Howe, spoke to Amendment No. 28. If he will forgive me, I shall not reopen the debate that we have already had this afternoon on NHS nursing care. We have difficulty with the amendment because we do not want to identify or single out in the Bill particular services that we think the NHS should be considering. To address the noble Earl's basic point, existing guidance is clear on NHS-funded nursing care. Anyone who is assessed as needing care in a care home providing nursing care will have a registered nursing care contribution carried out. Patients will be told the level of need and funding that the NHS will be paying on their behalf in the care home, regardless of the setting that a person is in—a hospital or wherever. The discharge good practice workbook will also make it clear that there will be a potential need for nursing care after a period of hospitalisation.

I hope that noble Lords will not press their amendments.

On Question, amendment agreed to.

[Amendments Nos. 12 to 14 not moved.]

7 p.m.

Baroness Barker moved Amendments Nos. 15 and 16:

    Page 3, line 4, after "consulting" insert "the patient and having obtained the informed consent of the patient or, in the case where a patient lacks the mental capacity to give such consent to the proposed care plan, having recorded on the file what steps have been taken to ensure that the patient's best interests have been duly considered, and after consulting"

    Page 3, line 4, after "body" insert "and the qualifying patient"

On Question, amendments agreed to.

[Amendments Nos. 17 to 19 not moved.]

Earl Howe moved Amendment No. 20:

    Page 3, line 5, at end insert—

"( ) Before making a decision under subsection (3), the responsible authority must—
(a) consult the patient and his carer, if he has one;
(b) inform them of the cost of the proposed care plans; and
(c) obtain the consent of the patient and any carer and, where informed consent is given, record that on the patient's file, or if a patient lacks the mental capacity to give such consent, record on the file what steps it has taken to ensure that the patient's best interests have been duly considered."

On Question, amendment agreed to.

[Amendment No. 21 not moved.]

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